"Attention has focused on oil insecurity, and rightly so, but it is not the same as food insecurity. An empty gas tank is one thing, an empty stomach another. And while there are substitutes for oil, there are none for food." –Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization.

Book Bytes

March 17, 2009

Better Health for All

Lester R. Brown

Ensuring basic health care for people in low-income countries is critical to the Plan B goal of eradicating poverty and stabilizing population. While heart disease and cancer (largely the diseases of aging), obesity, and smoking dominate health concerns in industrial countries, in developing countries infectious diseases are the overriding health concern. Besides AIDS, the principal diseases of concern are diarrhea, respiratory illnesses, tuberculosis, malaria, and measles. Child mortality is high.

Progress in reaching the United Nations (U.N.) Millennium Development Goal of reducing child mortality two thirds by 2015 is lagging badly. As of 2005 only 32 of 147 developing countries are on track to reach this goal. In 23 countries child mortality has either remained unchanged or risen. And only 2 of the World Bank’s 35 fragile states are on track to meet this goal by 2015.

Along with the eradication of hunger, ensuring access to a safe and reliable supply of water for the estimated 1.1 billion people who lack it is essential to better health for all. The realistic option in many cities now may be to bypass efforts to build costly water-based sewage removal and treatment systems and to opt instead for water-free waste disposal systems that do not disperse disease pathogens. This switch would help alleviate water scarcity, reduce the dissemination of disease agents in water systems, and help close the nutrient cycle—a win-win-win situation.

One of the most impressive health gains has come from a campaign initiated by a little-heralded nongovernmental group in Bangladesh, BRAC, that taught every mother in the country how to prepare oral rehydration solution to treat diarrhea at home by simply adding salt and sugar to water. BRAC succeeded in dramatically reducing infant and child deaths from diarrhea in a country that was densely populated, poverty-stricken, and poorly educated.

Seeing this great success, UNICEF used BRAC’s model for its worldwide diarrheal disease treatment program. This global administration of a remarkably simple oral rehydration technique has been extremely effective—reducing deaths from diarrhea among children from 4.6 million in 1980 to 1.6 million in 2006. Few investments have saved so many lives at such a low cost.

The war against infectious diseases is being waged on a broad front. Perhaps the leading privately funded life-saving activity in the world today is the childhood immunization program. In an effort to fill the gap in this global program, the Bill and Melinda Gates Foundation invested more than $1.5 billion through 2006 to protect children from infectious diseases like measles. Additional investment can help the many countries that cannot afford vaccines for childhood diseases and are falling behind in their vaccination programs. Lacking the funds to invest today, these countries pay a far higher price tomorrow. There are not many situations where just a few pennies spent per youngster can make as much difference as vaccination programs can.

One of the international community’s finest hours came with the eradication of smallpox, an effort led in the United Nations by the World Health Organization (WHO). This successful elimination of a feared disease, which required a worldwide immunization program, saves not only millions of lives but also hundreds of millions of dollars each year in smallpox vaccination programs and billions of dollars in health care expenditures. This achievement alone may justify the existence of the United Nations.

Similarly, a WHO-led international coalition has waged a worldwide campaign to wipe out polio, a disease that has crippled millions of children. Since 1988, Rotary International has contributed an extraordinary $600 million to this effort. Under this coalition-sponsored Global Polio Eradication Initiative, the number of polio cases worldwide dropped from some 350,000 per year in 1988 to fewer than 800 in 2003.

Unfortunately, progress against polio has begun to backslide. In mid-2003 religious leaders in northern Nigeria began to oppose the vaccination program on the grounds that it was a plot to spread AIDS and sterility. As a result, the number of cases of polio in Nigeria increased rapidly, tripling over the next three years. Meanwhile, Nigerian Muslims making their annual pilgrimage to Mecca may have spread the disease, bringing it back to some countries, such as Indonesia, Chad, and Somalia, that were already polio-free. In 2008 more than 1,600 cases were reported worldwide, and at present polio is still endemic in four countries: Nigeria, India, Pakistan, and Afghanistan.

One of the more remarkable health success stories is the near eradication of guinea worm disease, a global campaign launched by the U.S. Centers for Disease Control and Prevention (CDC) in 1980 and now led by former U.S. President Jimmy Carter and the Carter Center. These worms, whose larvae are ingested by drinking unfiltered water from lakes and rivers, mature in a person’s body, sometimes reaching more than two feet in length, and then exit slowly through the skin in a very painful and debilitating ordeal that can last several weeks. The global campaign has reduced the number of people infected by the worm from 3.5 million in 1986 to 25,217 cases in 2006—an astounding drop of 99 percent.

Some leading sources of premature death are lifestyle-related, such as smoking. WHO estimates that 5.4 million people died in 2005 of tobacco-related illnesses, more than from any single infectious disease. Today there are some 25 known health threats that are linked to tobacco use, including heart disease, stroke, respiratory illness, and many forms of cancer. Cigarette smoke kills more people each year than all other air pollutants combined—more than 5 million versus 3 million.

Impressive progress is being made in reducing cigarette smoking. After a century-long buildup of the tobacco habit, the world is turning away from cigarettes, led by WHO’s Tobacco Free Initiative. This gained further momentum when the Framework Convention on Tobacco Control, the first international accord to deal entirely with a health issue, was adopted unanimously in Geneva in May 2003. Among other things, the treaty calls for raising taxes on cigarettes, limiting smoking in public places, and strong health warnings on cigarette packages.

Ironically, the country where tobacco originated is now leading the world away from it. In the United States, the average number of cigarettes smoked per person has dropped from its peak of 2,814 in 1976 to 1,225 in 2006—a decline of 56 percent. Worldwide, where the downturn lags that of the United States by roughly a dozen years, usage has dropped from the historical high of 1,027 cigarettes smoked per person in 1988 to 859 in 2004, a fall of 16 percent. Media coverage of smoking’s health effects, mandatory health warnings on cigarette packs, and sharp increases in cigarette sales taxes have contributed to the steady decline. Indeed, smoking is falling in nearly all the major cigarette-smoking countries, including such strongholds as France, China, and Japan.

Following approval of the Framework Convention in 2003, a number of countries took strong steps to reduce smoking. Ireland imposed a nationwide ban on smoking in workplaces, bars, and restaurants; India banned smoking in public places; and Norway and New Zealand banned smoking in bars and restaurants. Bhutan, a small Himalayan country sandwiched between India and China, has prohibited tobacco sales entirely. More recently, England has forbidden smoking in workplaces and enclosed public spaces, and France has phased in a similar ban.

Looking more broadly, a 2001 WHO study analyzing the economics of health care in developing countries concluded that providing the most basic health care services, the sort that could be supplied by a village-level clinic, would require donor grants averaging just $33 billion per year. In addition to basic services, this $33 billion includes funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria and for universal childhood vaccinations. Such an effort would yield enormous economic benefits for developing countries and for the world as a whole.